<!DOCTYPE html>
<html>
<head>
<meta charset="UTF-8">
<link rel="stylesheet" type="text/css" media="screen" href="../../css/bootstrap.min.css">
</head>
<body>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12">
	<form class="form-horizontal" onsubmit="return false" id="form">
		<fieldset>
			<div class='form-group'>
				<label class='col-md-2 control-label'>regsterpayid</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='regsterpayid' type='text' name='regsterpayid' id='regsterpayid' data-bv-notempty='true' data-bv-notempty-message='regsterpayid 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>hostcode</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='hostcode' type='text' name='hostcode' id='hostcode' data-bv-notempty='true' data-bv-notempty-message='hostcode 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>titletype</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='titletype' type='text' name='titletype' id='titletype' data-bv-notempty='true' data-bv-notempty-message='titletype 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>title</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='title' type='text' name='title' id='title' data-bv-notempty='true' data-bv-notempty-message='title 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>count</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='count' type='text' name='count' id='count' data-bv-notempty='true' data-bv-notempty-message='count 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>doctor</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='doctor' type='text' name='doctor' id='doctor' data-bv-notempty='true' data-bv-notempty-message='doctor 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>doctorcode</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='doctorcode' type='text' name='doctorcode' id='doctorcode' data-bv-notempty='true' data-bv-notempty-message='doctorcode 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>fee</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='fee' type='text' name='fee' id='fee' data-bv-notempty='true' data-bv-notempty-message='fee 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>reghour</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='reghour' type='text' name='reghour' id='reghour' data-bv-notempty='true' data-bv-notempty-message='reghour 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>reghalf</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='reghalf' type='text' name='reghalf' id='reghalf' data-bv-notempty='true' data-bv-notempty-message='reghalf 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>specialty</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='specialty' type='text' name='specialty' id='specialty' data-bv-notempty='true' data-bv-notempty-message='specialty 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>remark</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='remark' type='text' name='remark' id='remark' data-bv-notempty='true' data-bv-notempty-message='remark 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>extparam1</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='extparam1' type='text' name='extparam1' id='extparam1' data-bv-notempty='true' data-bv-notempty-message='extparam1 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>extparam</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='extparam' type='text' name='extparam' id='extparam' data-bv-notempty='true' data-bv-notempty-message='extparam 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>deptcode</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='deptcode' type='text' name='deptcode' id='deptcode' data-bv-notempty='true' data-bv-notempty-message='deptcode 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>deptname</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='deptname' type='text' name='deptname' id='deptname' data-bv-notempty='true' data-bv-notempty-message='deptname 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>marktype</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='marktype' type='text' name='marktype' id='marktype' data-bv-notempty='true' data-bv-notempty-message='marktype 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>cliniclabel</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='cliniclabel' type='text' name='cliniclabel' id='cliniclabel' data-bv-notempty='true' data-bv-notempty-message='cliniclabel 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>registerway</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='registerway' type='text' name='registerway' id='registerway' data-bv-notempty='true' data-bv-notempty-message='registerway 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>flagused</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='flagused' type='text' name='flagused' id='flagused' data-bv-notempty='true' data-bv-notempty-message='flagused 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>flagavailable</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='flagavailable' type='text' name='flagavailable' id='flagavailable' data-bv-notempty='true' data-bv-notempty-message='flagavailable 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>clinicposition</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='clinicposition' type='text' name='clinicposition' id='clinicposition' data-bv-notempty='true' data-bv-notempty-message='clinicposition 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>clinicfee</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='clinicfee' type='text' name='clinicfee' id='clinicfee' data-bv-notempty='true' data-bv-notempty-message='clinicfee 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>appointcount</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='appointcount' type='text' name='appointcount' id='appointcount' data-bv-notempty='true' data-bv-notempty-message='appointcount 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>regcount</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='regcount' type='text' name='regcount' id='regcount' data-bv-notempty='true' data-bv-notempty-message='regcount 不能为空'>
				</div>
			</div>
			<div class='form-group'>
				<label class='col-md-2 control-label'>dqcode</label>
				<div class='col-md-10'>
					<input class='form-control' placeholder='dqcode' type='text' name='dqcode' id='dqcode' data-bv-notempty='true' data-bv-notempty-message='dqcode 不能为空'>
				</div>
			</div>


			<div class="form-actions">
				<div class="row" align="center">
					<div class="col-md-12">
					    <button class="btn btn-primary" onclick="location.href='appRegsterMarkList.html'">返回</button>
						<button class="btn btn-primary" type="submit" onclick="add()">
							<i class="fa fa-save"></i> 保存
						</button>
					</div>
				</div>
			</div>

		</fieldset>
	</form>
</div>
	<script type="text/javascript" src="../../js/libs/jquery-2.1.1.min.js"></script>
	<script type="text/javascript" src="../../js/jq.js"></script>
	<script type="text/javascript" src="../../js/plugin/bootstrapvalidator/bootstrapValidator.min.js"></script>
	<script type="text/javascript" src="../../js/common.js"></script>
	<script type="text/javascript" src="../../layui/layui.js"></script>
	<script type="text/javascript">
		layui.use(['layer','laydate'], function(){
		    var layer = layui.layer;
		});
		
		function add() {
			$('#form').bootstrapValidator();
			var bootstrapValidator = $("#form").data('bootstrapValidator');
			bootstrapValidator.validate();
		    if(!bootstrapValidator.isValid()){
			   return;
		    }
		    
		    var formdata = $("#form").serializeObject();

			$.ajax({
				type : 'post',
				url : '/appRegsterMarks',
				contentType: "application/json; charset=utf-8",  
				data : JSON.stringify(formdata),
				success : function(data) {
					layer.msg("添加成功", {shift: -1, time: 1000}, function(){
                        location.href = "appRegsterMarkList.html";
                    });
				}
			});
		}
		
	</script>
</body>
</html>
